Study on association of BMI with lung cancer in north indian population

Int. J. Life. Sci. Scienti. Res. March 2018
Copyright © 2015-2018| IJLSSR by Society for Scientific Research is under a CC BY-NC 4.0 International License Page 1680
Study on Association of BMI with Lung
Cancer in North Indian Population
Priyanka Gaur1
, Sandeep Bhattacharya1
*, Surya Kant2
, R.A.S. Kushwaha2
, Sarika Pandey2
,
Prashant Mani Tripathi2
, Rajeev Kumar2
1
Department of Physiology, King George’s Medical University, UP, Lucknow, Uttar Pradesh, India
2
Department of Respiratory Medicine, King George’s Medical University, UP, Lucknow, Uttar Pradesh, India
*
Address for Correspondence: Dr. Sandeep Bhattacharya, Professor, Department of Physiology, King George’s
Medical University, Lucknow- 226010, Uttar Pradesh, India
Received: 12 Dec 2017/Revised: 15 Jan 2018/Accepted: 22 Feb 2018
ABSTRACT- Background- Lung cancer is one of the most prevalent type of cancer in India. It is considered as the
most commonly diagnosed cancer and constitutes the leading cause of cancer related mortality. The majority of lung
cancer is due to smoking. Tobacco use has been reported to be one of the main causes of lung cancer. It has been
observed in previous studies that excess body weight and obesity are protective factors against lung cancer in current
and former smokers.
Material and Methods- The present study recruited 235 lung cancer patients. BMI was categorized as underweight
(BMI <18.5 kg/m2
), normal weight (BMI 18.5 to <25kg/m2
), overweight (BMI 25 to <30 kg/m2
) and obese (BMI≥30
kg/m2
). The study was conducted to establish the association of BMI with gender, smoking status, and histological
subtypes of lung cancer.
Results- Out of 235 patients enrolled, 55.32% were underweight, 40.43% were normal weight, 3.4% of patients were
classified as overweight and 0.85% was obese. This study shows significant association of BMI with smoking status
(p<0.0057) while non-significant association with gender (p=0.75) and histological subtypes (p=0.74).
Conclusion- We were concluded that significant association was found between BMI and smoking status while non
significant association was observed between BMI and gender as well as BMI and histological subtypes of lung cancer
patients in the north Indian population in this study.
Key-words- Lung Cancer, Mortality, Smoking, BMI, Histological Subtypes
INTRODUCTION
Lung cancer is one of the most prevalent types of cancer
in India and constitutes the leading cause of cancer
related mortality worldwide [1]
. Lung cancer is defined as
the uncontrolled cell growth of lung tissues which may
lead to metastasis, invasion of adjacent tissue and
infiltration beyond the lungs [2]
. The majority of lung
cancer cases are due to Tobacco smoking and other
environmental pollutants have been recognized as risk
factors for cancer. The average five-year survival rate
after diagnosis is low [3]
. It is essential to emphasize the
importance of Lung Cancer prevention, and knowledge of
modifiable risk factors such as environmental exposures,
tobacco smoking and air pollution is prevalent among
good quality epidemiological studies that explain the
majority of Lung Cancer incidence [4–7]
. The complex
interplay of etiological and psychophysical factors is
believed to modify the effect of respiratory carcinogens
on lung cancer initiation and prognosis [8,9]
.
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DOI: 10.21276/ijlssr.2018.4.2.11
BMI is defined as a person's weight in kilograms divided
by the square of height in meters and is often used in
epidemiologic studies as an approximate measure of
general body fat. In a Meta-analysis, strong associations
were observed between BMI and different types of
cancers such as esophagus, thyroid, colon, kidneys, and
endometrium gallbladder while weaker associations were
shown for several other sites [10]
. Several observational
epidemiological studies have shown that higher BMI
correlates with a lower risk of Lung Cancer [11]
. Two
recent meta-analyses have provided more evidence
supporting the idea that excess weight could significantly
decrease the risk of Lung Cancer [12,13]
. It has been
observed that excess body weight and obesity are
protective factors against Lung Cancer especially in
current and former smokers. Despite this, the inverse
association between BMI and Lung Cancer is often
criticized due to inadequate adjustment for cigarette
smoking [14].
Moreover, BMI has been found to be
unrelated to Lung Cancer in non-smokers [15,16]
Previous
Research has suggested that body-mass index (BMI) is an
important predictor of cancer risk [17]
. It has been found
from the various studies that there is a direct relationship
between unhealthy diet and lifestyle with the increased
risk of tumor development and cancer. Hence a good
nutritional status based on a balanced diet constitutes one
of the main preventive factors for tumors. It has been
RESEARCH ARTICLE

concluded from various studies that the use of tobacco,
cigarette smoking, regular use of alcohol increase risk of
lung cancer while regular intake of fruits such as apples,
banana, fresh vegetables such as tomato, carrot, and milk
products have protective effects against lung cancer.
[18,19]
. The association between BMI and the risk of Lung
Cancer stratified by smoking status has important public
health implications. This study aims to establish the
association of BMI with the gender, smoking status and
histological subtypes of lung cancer patients in north
Indian populations.
MATERIALS AND METHODS
Present study was conducted at the Department of
Respiratory Medicine King George’s Medical University,
Lucknow, India. Total of 235 histopathologically
confirmed lung cancer patients were enrolled in this study
after excluding those having other disorders such as
COPD, asthma, tuberculosis, interstitial lung disease. The
study was approved by the institutional ethics committee.
The patients were recruited after given informed consent.
The information regarding the lung cancer risk factors
including smoking status and number of cigarettes
smoked per day, time since quitting smoking were also
recorded on the questionnaire. The Body mass index
(BMI) was calculated by dividing the body weight in
kilograms by the height in meters square (kg/m2
).
According to the WHO international classification,
defined body mass was categories as follows:
underweight (BMI<18.5 kg/m2
), normal (BMI=18.5–24.9
kg/m2
), overweight (BMI=25–29.9 kg/m2
), and obese
(BMI ≥ 30 kg/m2
).
Statistical Analysis- The data were analyzed by graph-
pad prism version 5. The data were presented in mean,
SD and percentage. The chi-square test was used for
categorical data. The p value <0.05 was considered
statistically significant in all analyses.
RESULTS
A total of 235 patients were enrolled in this study. The
demographic characteristic of the lung cancer patient is
represented in Table 1. The study comprises 80.69%
(163) male and 35.64% (72) female. Among the
histological types, adenocarcinoma was the most
common, which comprises 48.51% (114) of lung cancer
patients followed by squamous cell carcinoma 45.11%
(106) and small cell carcinoma 3.40% (8) while 2.98%
(7) of the patients were other subtypes. The majority of
patients i.e. 96.60% (227) were in stage III/IV while only
3.40% (8) were in stage I/ II. Current and ex-smokers
included in this study were 45.96% (108) and 34.89%
(82) while the never-smokers in the patient population
were 19.15% (45).
Table 1: Demographic Profile of Lung Cancer
Patients
Lung cancer patients were categorized into four groups
according to WHO classification as:
Group 1: Underweight (BMI<18.5 kg/m2
)
Group 2: Normal (BMI= 18.5–24.9 kg/m2
)
Group 3: Overweight (BMI= 25–29.9 kg/m2
)
Group 4: Obese (BMI≥ 30 kg/m2
)
Highest proportions of patients were found in the Group 1
which comprises 55.32% (130), followed by Group 2,
40.43% (95) and Group 3, 3.40% (8), Group 4 contains
0.85% (2) of lung cancer patients (Fig. 1).
Fig. 1: Distribution of lung cancer patients according
to BMI
Parameters Lung Cancer Patients
(N=235)
Age 55.69±10.27
Sex
Male
Female
163(80.69%)
72(35.64%)
Smoking History
Smoker
Ex- Smoker
Non Smoker
108(45.96%)
82(34.89%)
45(19.15%)
Histology
Adenocarcinoma
Squamous Cell Carcinoma
Small Cell Carcinoma
Other
114(48.51%)
106(45.11%)
8(3.40%)
7(2.98%)
Stage
I/II
III/IV
8(3.40%)
227(96.60%)

Male and female lung cancer patients were categorized
according to BMI (Fig. 2). Out of 130 Lung cancer
patients 70% (91) male, and 30% (39) female were
present in Group 1 while in Group 2, out of 95 lung
cancer patients, 67.37 % (64) male, and 32.63% (31)
female were present and Group 3 comprises 75 % (6)
male and 25% (2) female. In Group 4, lung cancer
patients were 100% (2) male for this study.
Fig. 2: Distribution of Male and Female Lung Cancer
Patients according to BMI
Smoker, Ex-smoker and Non-smoker lung cancer patients
were categorized according to BMI (Fig. 3). In Groups 1
out of 130 patients, highest no. of smoker 56.9% (74)
were present, followed by Non-smoker 26.9% (35) and
Ex- smoker 16.2% (21).Groups 2 of lung cancer patients
also comprises highest no. of smoker33.7% (32),
followed by Non-smoker 42.2%(42) and then Ex- smoker
22.1% (21). Groups 3 comprises 25% (2), 37.5% (3)
Non-smoker and37.5 % (3) Ex- smoker. While Groups 4
having only Non-smoker100% (2) in this study.
Fig. 3: Showing distribution of Smoker, Non-smoker
and Ex-smoker Lung Cancer Patients according to
BMI
Distribution of histological subtypes of Lung Cancer
Patients according to BMI (Fig. 4). Group 1 of the lung
cancer patients, having 44.62% (58) Adenocarcinoma,
49.23% (64) Squamous cell carcinoma, 2.31% (3) Small
cell carcinoma and 3.85% (5) other types and 53.68%
(51) Adenocarcinoma, 40% (38) Squamous cell
carcinoma, 5.26% (5) Small cell carcinoma and 1.02%
(1) of other types were found in Group 2 of lung cancer
patients. Group 3comprises 62.5% (5) Adenocarcinoma,
37.5% (3) Squamous cell carcinoma, while Group 4,
having 50% (1) Adenocarcinoma, 50% (1) Squamous cell
carcinoma.
Fig. 3: Showing distribution of histological subtypes of
Lung Cancer Patients according to BMI
Present study shows significant association between BMI
and smoking status (p<0.005) while non significant
association were found between BMI and gender
(p=0.75) as well as between BMI and histological
subtypes (p=0.74).
DISCUSSION
It has been shown by the previous studies that BMI
appears to be inversely related to lung cancer [20-35]
.
Smoking is a powerful risk factor for lung cancer and is
also inversely associated with body weight according to
the previous study [36]
. Lower BMI was observed in lung
cancer patients. The high no. of 130 (55.3%) lung cancer
patients were found in group1 (BMI< 18.5 kg/m2
) in this
study. In the previous study, it has been reported that
44.3% of the lung cancer patients were underweight.
Previous study investigating that BMI-LC associations
has conventionally stratified for smoking status. The
Strong inverse association was observed between BMI
and the lung cancer among smokers [37]
. In this study
highest no. of smokers 56.9% (74) were also found in
Group 1 (BMI<18.5 kg/m2
) followed by Group 2 which
were having 33.7% (32) smokers and Group 3 having
25% (2) of smokers. The Results of the present study
shows the significant association of BMI with the
smoking status of the lung cancer patients (p<0.005). The
finding that obesity has been associated with a reduced
lung cancer risk may be due to the confounding caused by
smoking because smoking habits affect both body weight
and body composition [38,39]
. The previous study examined
the association of BMI before diagnosis and
adenocarcinoma adjusted for age and smoking status.
Men with BMI in the leanest category (BMI<20.8) at 3
years before diagnosis and with BMI in the highest
category (BMI≥25.0) at 3 to 4 years before diagnosis had
increased risk of adenocarcinoma but in 1 year, 2 years,
and 5 years before the diagnosis and non-significant
association between BMI and adenocarcinoma in men
was found. In women no inverse association was

observed between BMI at 1 to 5 years before diagnosis
and adenocarcinoma. Previous study also showed an
increased risk of lung cancer for lower BMI at the time of
lung cancer diagnosis in men after stratification by
smoking status. The previous study has shown that the
association between leanness and risk of lung cancer was
also found at 1 to 2 years before the diagnosis of the lung
cancer. The association between lower BMI and lung
cancer was found in men the majority of whom were
smokers [40]
.
It has been examined in a previous study that the
association of anthropometric factors stratified by
histological type of lung cancer revealed an inverse
association between BMI and adenocarcinoma of the lung
among never-smokers [41]
Several previous studies have
reported an association between leanness and lung cancer
mainly in smokers [42,43]
. In the present study, non-
significant association was observed between BMI and
gender (p=0.75) as well as between BMI and histological
subtypes (p=0.74) of lung cancer patients in North Indian
Population.
CONCLUSIONS
In the present study, we found a significant association
between BMI and smoking status while non-significant
association between BMI and gender as well as between
BMI and histological subtypes in lung cancer patients in
North Indian Population. It has been shown by various
studies that the use of tobacco, cigarette smoking, and
regular use of alcohol increase risk of lung cancer while
regular intake of fruits such as apples, banana, fresh
vegetables like tomato, carrot, and milk products have
protective effects against lung cancer. The higher no of
lung cancer patients were underweight in this study.
Therefore, it has been suggested that the good nutritional
status based on a balanced diet constitutes one of the
preventive factors for tumors.
ACKNOWLEDGMENT
We are greatly thankful to department of Respiratory
Medicine, King George’s Medical University, Lucknow,
India and also appreciates patients participating in this
study.
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How to cite this article:
Gaur P, Bhattacharya S, Kant S, Kushwaha RAS, Pandey S, Tripathi PM, Kumar R. Study on Association of BMI with Lung
Cancer in North Indian Population. Int. J. Life. Sci. Scienti. Res., 2018; 4(2): 1680-1684. DOI:10.21276/ijlssr.2018.4.2.11
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